Publications by authors named "Joelle Kefer"
Background: Despite the excellent success and safety of intravascular lithotripsy (IVL) in heavily calcified lesions, evidence in acute coronary syndromes (ACS) remains limited.
Aims: This study aimed to evaluate the procedural and clinical outcomes of IVL in heavily calcified ACS.
Methods: Patients who underwent IVL between 2019 and 2024 from the ongoing prospective BENELUX registry were eligible for inclusion.
Article Synopsis
- * A total of 454 patients were included, with more men than women, and women showed higher rates of acute coronary syndrome and aorto-ostial lesions.
- * Results indicated that despite differences in clinical presentation, the safety and efficacy outcomes of IVL were comparable between men and women, demonstrating its effectiveness across genders.
Background: Intravascular lithotripsy (IVL) is increasingly used for treatment of coronary artery calcification. This study aimed to evaluate contemporary utilisation patterns, safety and efficacy of IVL in an unselected real-world patient cohort.
Methods: We included 454 patients undergoing IVL from May 2019 to February 2024 across seven centres in two European countries.
Background: Percutaneous coronary intervention of calcified aorto-ostial lesions (AOL) pose unique challenges due to anatomical propensity for recoil, leading to poorer outcomes compared to non-AOL. Although intravascular lithotripsy (IVL) has shown excellent success and safety in heavily calcified plaques, evidence specific to AOL is limited. This study aims to evaluate the efficacy and safety of IVL in AOL versus non-AOL.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the use of intravascular lithotripsy (IVL) in treating heavily calcified chronic total occlusions (CTOs), noting that calcification leads to worse patient outcomes.
- It analyzes data from 404 patients, finding that procedural success rates and safety outcomes were similar for both CTO and non-CTO patients.
- The conclusion emphasizes that IVL is effective and safe for managing heavily calcified lesions, supporting its use in clinical practice.
Article Synopsis
- - TAVI with the SAPIEN 3 device has demonstrated significant clinical advantages over traditional surgical aortic valve replacement (SAVR) for low-risk patients, as shown by the PARTNER 3 trial.
- - The cost-utility analysis, tailored for Belgium, found that TAVI could lead to savings of €3,013 per patient, despite higher initial costs due to reduced follow-up expenses like rehabilitation and rehospitalization.
- - Overall, the findings suggest that TAVI offers a beneficial and cost-effective alternative for low-risk patients with severe symptomatic aortic stenosis in Belgium, outpacing SAVR in both quality of life and financial outcomes.
Article Synopsis
- Left atrial appendage (LAA) occluder embolization is a rare but critical complication occurring mostly within the first 24 hours after the procedure, with data collected from 67 centers on 108 patients.
- The management strategies included attempting percutaneous retrieval in 75% of cases, while 21.3% of patients underwent surgery without prior attempts, highlighting significant mortality rates associated with multiple retrieval attempts.
- Overall, a major adverse event rate of 43.5% was observed, underscoring the serious risks, including death, particularly following unsuccessful retrievals.
Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study.
JACC Cardiovasc Interv
February 2024
Article Synopsis
- The COVID-19 pandemic led to significant treatment delays for patients needing transcatheter aortic valve replacement (TAVR), with a marked decrease in procedure volumes during the first two waves of the pandemic.
- The study analyzed TAVR case data from 130 centers in 61 countries, finding a 15% drop in cases during the first wave and 7% in the second, particularly affecting regions like Africa, Central-South America, and Asia.
- Factors such as hospital type (private vs public), urban vs rural location, low procedure volumes, a country's socioeconomic status, and stringent public health measures contributed to these reductions, highlighting the need for improved public health policies for future health crises.
Aortic Coarctation Stenting in Adolescents and Adults: A Single-Center Experience.
Vasc Endovascular Surg
November 2023
Purpose/background: The aim of this study was to evaluate the short and midterm results of aortic coarctation (AoCo) stenting in an adolescent and adult population.
Methods: All patients with a AoCo older than 14 years treated by stent placement between December 2000 and November 2016 were included in this study. Twenty-eight patients with an invasive peak systolic pressure gradient >20 mmHg were identified.
Objectives: This study aimed to assess discordance between results of instantaneous wave-free ratio (iFR), fractional flow reserve (FFR), and intravascular ultrasound (IVUS) in intermediate left main coronary (LM) lesions, and its impact on clinical decision making and outcome.
Methods: We enrolled 250 patients with a 40%-80% LM stenosis in a prospective, multicenter registry. These patients underwent both iFR and FFR measurements.
Purpose: Decision-making on transcatheter aortic valve replacement (TAVR) in patients aged 75 years and older is complex. It could be facilitated by the identification of predictors of long-term mortality. This study aimed to identify predictors of 2-year mortality to develop a 2-year mortality risk score.
View Article and Find Full Text PDFBackground: When performing transcatheter left atrial appendage (LAA) closure, peridevice leaks and device-related thrombus (DRT) have been associated with worse clinical outcomes-hence, their risk should be mitigated.
Objectives: The authors sought to assess whether use of preprocedural computational modeling impacts procedural efficiency and outcomes of transcatheter LAA closure.
Methods: The PREDICT-LAA trial (NCT04180605) is a prospective, multicenter, randomized trial in which 200 patients were 1:1 randomized to standard planning vs cardiac computed tomography (CT) simulation-based planning of LAA closure with Amplatzer Amulet.
Partial anomalous pulmonary venous return in adults: Insight into pulmonary hypertension.
Int J Cardiol Congenit Heart Dis
March 2023
Background: Partial anomalous pulmonary venous return (PAPVR) is a rare condition that may lead to pulmonary arterial hypertension (PAH). We sought to determine the prevalence of PAPVR, the follow-up rate of incidentally discovered PAPVR, the repercussions of volume and pressure overload on the right ventricle (RV), and the prevalence and predictors of PAH.
Methods And Results: Fifty PAPVR patients aged ≥18 years were included.
Background: The optimal duration of antithrombotic therapy (ATT) after patent foramen ovale (PFO) closure remains under debate. This study sought to compare the clinical outcome of patients receiving antithrombotic agents for a short (6 months) versus extended (>6 months) period after the procedure.
Methods: This was a retrospective cohort study using a propensity score matching analysis on 259 consecutive patients (131 males, 43 ± 10 years) undergoing PFO closure due to cryptogenic stroke, with complete follow-up (median duration of 10 [4-13] years).
Article Synopsis
- The study compares distal radial access (DRA) and conventional transradial access (TRA) for coronary procedures, focusing on the incidence of radial artery occlusion (RAO), a common complication of TRA.
- In a trial with 1,307 patients, results showed no significant difference in RAO rates between the two methods (0.91% for TRA vs 0.31% for DRA), but DRA had a higher crossover rate (7.4% vs 3.5%) and shorter hemostasis time (153 minutes vs 180 minutes).
- Both methods resulted in similar rates of overall bleeding and complications, suggesting that DRA could be an effective alternative to
Background And Aims: Abdominal coarctations are rare. Surgical treatment is difficult and requires re-interventions to adjust the graft material to patient growth. We report effective treatment by interventional catheterization in an infant with the concern to allow adjustment for growth and prevention of vessel damage.
View Article and Find Full Text PDFBackground: Transradial access (TRA) has become the default access method for coronary diagnostic and interventional procedures. As compared to transfemoral access, TRA has been shown to be safer, cost-effective and more patient-friendly. Radial artery occlusion (RAO) represents the most frequent complication of TRA, and precludes future coronary procedures through the radial artery, the use of the radial artery as a conduit for coronary artery bypass grafting or as arteriovenous fistula for patients on hemodialysis.
View Article and Find Full Text PDFBackground: Non-flow-limiting nonculprit lesions (NCL) that contain a large lipid-rich necrotic core (nonculprit lipid-rich plaques (NC-LRP)) are most likely to cause recurrent acute coronary syndrome after ST-elevation myocardial infarction (STEMI). Near-infrared spectroscopy (NIRS) detects LRPs using the maximum 4 mm lipid-core burden index (maxLCBI). Few data are available regarding NIRS-guided therapy of these NC-LRPs, which are a potential target for preventive stenting.
View Article and Find Full Text PDFBackground: Optimal preprocedural planning is essential to ensure successful device closure of the left atrial appendage (LAA).
Design: The PREDICT-LAA study is a prospective, international, multicentre, randomised controlled trial (ClinicalTrials.gov NCT04180605).
Background: Although 1-month dual antiplatelet therapy (DAPT) in patients treated with bare metal stents (BMS) is well established, the optimal duration of DAPT after implantation of a drug-eluting stent (DES) is still a matter of debate. The safety of shortened DAPT is under investigation due to concern about the risk of stent thrombosis. Data on platelet activation and prothrombotic response in vivo following bioresorbable polymer sirolimus-eluting stent (BP-SES) implantation are scarce.
View Article and Find Full Text PDFThe proposed 2020 Core Curriculum for Percutaneous Cardiovascular Interventions aims to provide an updated European consensus that defines the level of experience and knowledge in the field of percutaneous cardiovascular intervention (PCI). It promotes homogenous education and training programmes among countries, and is the cornerstone of the new EAPCI certification, designed to support the recognition of competencies at the European level and the free movement of certified specialists in the European Community. It is based on a thorough review of the ESC guidelines and of the EAPCI textbook on percutaneous interventional cardiovascular medicine.
View Article and Find Full Text PDFObjectives: To evaluate how pulmonary artery (PA) distensibility performs in detecting pulmonary hypertension due to left heart disease (PH-LHD) in comparison with parameters from ungated computed tomography (CT) and echocardiography.
Methods: One hundred patients (79 men, mean age = 63 ± 17 years) with either severe heart failure with reduced ejection fraction (HFrEF), aortic stenosis, or primary mitral regurgitation prospectively underwent right heart catheterization, ungated CT, ECG-gated CT, and echocardiography. During the ECG-gated CT, the right PA distensibility was calculated.
Background: Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR-induced left bundle branch block (LBBB).
Methods: Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant.